Can Baltimore Provide Addiction Treatment On Demand?

Dr. Leana Wen, the Baltimore City health commissioner, is working to match addiction treatment with demand.

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Originally published on February 25, 2016 2:43 pm

Across the U.S., more than 20 million people abuse drugs or alcohol or both. Only about 1 in 10 is getting treatment.

People seeking treatment often have to wait weeks or months for help. The delays can jeopardize the chances they'll be able to recover from their addiction.

In Baltimore, Health Commissioner Leana Wen has been pushing for treatment on demand, so that the moment people decide they're ready for help, it's available. It's something other health officials have sought to achieve, without success.

Towson, known in her West Baltimore neighborhood as Teacup, has used heroin on and off for more than 30 years. She considers herself an active user.

By mid-December, she was looking to change that. "For the new year, I want to be in treatment," she says.

With the help of health department outreach worker Nathan Fields, Towson was able to get an appointment at a rehab center just before Christmas. But Fields, a former heroin user, says even a wait as short as a week can be too long.

"So many other things can happen," he says. "One thing, she could die. She could overdose, because if she's feeling dopesick she's going to use."

Fields knows that beating an addiction doesn't often happen on the first try. He also knows that the feelings of loneliness that can drive a person to seek help can be fleeting.

"Heroin has always been a great companion for people that are dependent," he says. "Best friend. It can talk to you. It can reason with you."

In Baltimore, Wen says there are an estimated 20,000 people who use heroin and 65,000 with some kind of addiction to drugs or alcohol or both, even after decades of focus on the issue.

In the 1990s, Baltimore made headlines when then-Mayor Kurt Schmoke introduced what he called a medicalized approach to the drug epidemic. His view, that the drug epidemic was a public health problem and not just a criminal justice one, was highly controversial at the time.

In 1997, billionaire George Soros gave the city $25 million to come up with innovative ideas for addressing, among other things, drug addiction, and the movement for treatment on demand gained momentum.

Nearly two decades later, Wen, who has been the city's health commissioner for a little over a year, isn't certain that treatment on demand is even possible. "We can progress, because we're so far off from it," she says. "We're so far off."

A bright spot is a 24-7 phone line for addiction and mental health resources the city launched last year that is fielding about a thousand calls a week. It's a big improvement from the past, Wen says, when it wasn't even clear whom one could call.

"It's not getting them treatment on demand," she says. "But it's getting them treatment at some point soon and resources right now."

Wen's team is also working on bigger projects she hopes will shorten wait times for treatment. One is a database that would show how many treatment slots are available at that moment across the city.

"What I worry about is, maybe there are spots that are available, but we're not able to fill them," she says.

Even with a tool like the database, Wen says it is time to rethink options for addiction treatment. "Maybe some people don't need treatment as an inpatient stay at the moment they request it," she says.

Another option, medication-assisted treatment on an outpatient basis, still carries a stigma, which concerns Wen. "There is the misguided belief out there that methadone, buprenorphine treatment is replacing one addiction with another," she says. "That is not true. Methadone and buprenorphine are proven, evidenced-based treatments endorsed by every medical organization."

There are other services she sees as critical to the recovery process that she wants recognized as part of the treatment system,such as peer-recovery specialists and case managers, who follow people through the process.

Wen is calling for Medicaid and insurers to cover the services, which are largely paid for now by grants. She hopes the national conversation taking place around addiction will lead lawmakers to spur such a change.

Still, all of this seems a long way off for Teacup.

In the middle of January, Andrea Towson was back on a park bench in West Baltimore, having missed her goal of getting into treatment by the new year.

"I want this chapter of my life to close, just end. I'm done. And it's not happening fast enough," she said, "Right now, I'm just ready."

Towson had yet another appointment at a rehab center the following week, but she was pretty sure it was just an interview and that she would have to keep waiting. She says, even if she were offered a spot, she wasn't sure she had the will to go.

"If somebody came up and said 'Andrea, you can get into treatment right now,' you know what I would say? Can you get me well first," she says.

This is how she talks about her addiction. She's well when she's had a hit. She's sick without the drugs.

"I just want to wake up and eat breakfast and be normal, no matter what that might be," she says. "I'm just ready to be Andrea. Teacup is done. She'll always be a part of me, but I no longer want to be her. Teacup is a full-blown drug addict. Full-blown. I choose to live now."

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AUDIE CORNISH, HOST:

Here are some sobering numbers - across the U.S., more than 20 million people abuse drugs or alcohol or both, and only about 1 in 10 of them is getting treatment. People seeking treatment often have to wait weeks or months. Looking to change that, President Obama's latest budget includes new funding to expand drug treatment. Here he is last fall.

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BARACK OBAMA: With no other disease do we expect people to wait until they're a danger to themselves or others to-self diagnose and seek treatment. Every other disease - you got a broken leg, you got diabetes, you got some sort of sickness, we understand that we got to get you help.

CORNISH: He's not the only one talking about this on Capitol Hill. Lawmakers on both sides of the isle have testified about how addiction has ravaged their communities. On the campaign trail, Ted Cruz and Jeb Bush, among others, have shared heart-wrenching stories about their own families. And in Baltimore, where we've been following Health Commissioner Leana Wen, there's a big push for instant access to treatment. The minute someone says I'm ready for help, they get it. Now the need for such treatment-on-demand became clear to us when we caught up with someone we first introduced to you last fall, someone who goes by the name Teacup.

ANDREA TOWSON: That's my nickname.

CORNISH: What is it?

TOWSON: Teacup.

CORNISH: Her real name is Andrea Towson. She's a 50-year-old grandmother of two from west Baltimore, and she's an addict.

TOWSON: I am. I'm an active heroin user - 33 years, as a matter of fact.

CORNISH: After our story aired, the comments we got were peppered with insults, calling her junkie, referring to addicts as scumbags. Several of you asked, why doesn't she just treatment? The question I'd asked her myself in the story - don't you need to get clean?

TOWSON: I absolutely do. Can you help me, please? Actually, that's my next thing.

CORNISH: But as Teacup's story shows, it's not so simple. All right, so let's go back to just before Christmas. I got a text from Nathan Fields. He's a health department outreach worker who's known Teacup for years. He knew we were interested in following up. Have Teacup here, he wrote, talking to her about a treatment center. We called him right away, and he put her on the phone with us.

TOWSON: For the new year, I want to be in treatment for at least the first of the year - be in treatment.

CORNISH: So you want to be in treatment for the new year?

We were hunched over a cell phone in the middle of the newsroom. Teacup tells us that Nathan Fields had called around and gotten her an appointment at a treatment center for the following week, even offered to drive her there.

Are you going to be with Nathan tomorrow, or where could we find you?

She sounds excited, and she agrees to meet with us.

TOWSON: All right, I'll see you tomorrow.

CORNISH: All right, thanks.

TOWSON: All right, baby, see you tomorrow. Bye-bye.

CORNISH: The next morning, we head to West Baltimore. And sure enough, we find Teacup on the street corner, exactly where she said she'd be.

Hey, Teacup. It's me, Audie. Hey.

TOWSON: I thought that was you.

CORNISH: How are you? Come on to the car.

It's cold. It's pouring rain. It's 9 in the morning. We're standing across from the Upton Avenue Market subway station. And Teacup is in no mood for an interview.

TOWSON: You know I always be honest. I haven't had no dope yet, so it's going to be a minute because it's raining.

CORNISH: Teacups twin missions - get high to stop feeling sick; get money to get high. In this case, a friend is going to pay Teacup to style her hair. Her own hair is wrapped in a silk scarf, and she's wearing brown, knee-high leather boots. Her eyes are scanning and scanning the street behind me. This is a known open-air drug market. A man next to Teacup doesn't think we should be standing here, even in broad daylight.

UNIDENTIFIED MAN: It's not safe for y'all on this corner.

TOWSON: They know.

CORNISH: Teacup tells us to wait in the car. But after two hours, she's disappeared. Now, Teacup says she wants to change, but an appointment a week away - to an addict, seven days might as well be a lifetime. Nathan Fields wasn't surprised that a day after he scheduled her appointment Teacup was back out trying to get drugs, but he was worried.

NATHAN FIELDS: So many other things can happen. One thing - she could die. She could overdose because if she's feeling dope sick, she's going to use, you know? She's going to find a means to use.

CORNISH: He knows because he beat his heroin addiction decades ago, and it did not happen on the first try. He says the feelings that drive you to want to get help can be fleeting.

FIELDS: That feeling of being alone, being by yourself. Heroin has always been a great companion for people that are dependent - best friend. It can talk to you. It can reason with you.

CORNISH: Today, there are an estimated 20,000 people in Baltimore using heroin, 65,000 with some kind of addiction to drugs or alcohol - this after decades of focus on the issue. In the 1990s, the city made headlines when then-Mayor Kurt Schmoke introduced what he called a medicalized approach to the drug epidemic. His view - that it was a public health problem, not just a criminal justice one - was controversial. It was during that time that billionaire George Soros gave the city $25 million to come up with innovative ideas. And the movement for treatment-on-demand gained momentum. New programs were launched. Progress was made, but it was not nearly enough. We asked Health Commissioner Leana Wen if she thinks treatment-on-demand today is even possible.

LEANA WEN: Honestly, I'm not sure. I think we can progress because we're so far off from it. We're so far off.

CORNISH: So she's trying to tackle some big-picture problems - first, inventory. In Baltimore, they don't even know how many treatment beds or slots exist because there is little organization or oversight of treatment providers. So she's got staff working on a new system that will show, in real time, what's available at treatment centers across the city. And second, Dr. Wen says it's time to rethink what treatment looks like. She says don't assume it's all about detox and rehab. She'd like to see more people in outpatient treatment - methadone or buprenorphine programs. And she says treatment has to include counseling and social support.

WEN: How about a peer recovery specialist? How about individuals that will connect people into treatment in the first place? How about supportive housing?

CORNISH: These are ideas that are gaining traction, in part because there's this big national conversation taking place about addiction, which, by the way, isn't lost on the people of Baltimore.

WEN: At a lot of community events that I've gone to, people have expressed their anger that now that there are white kids dying of overdose and white middle-class women dying of overdose that now we care about this issue, when, actually, in Baltimore city we've had people dying from overdose, we've had addiction in the city for decades.

CORNISH: But Leana Wen, always the pragmatist, sees an opportunity.

WEN: Because of the conversation happening around the country and, yes, in some wealthy areas, too, there is funding that can potentially be leveraged to enable us to do treatment-on-demand in a way that was not available before.

CORNISH: But, you know, this is all a long way away for someone like Teacup. Last month, we found Andrea Towson steps away from the street corner where we'd last seen her that rainy day in December. She clearly hadn't made it into treatment.

ANDREA HSU, BYLINE: What's up, Teacup?

TOWSON: Hi, baby. How are you?

UNIDENTIFIED WOMAN: Who's that?

TOWSON: My friend.

CORNISH: It was actually my producer, Andrea Hsu.

HSU: How are you feeling today?

TOWSON: I don't feel well. I'm irritable. I want this chapter my life to close, just end. I'm just - I'm done. And it's not happening fast enough. And I know it's me. It's the role that I play. But now I'm broken. Spiritually, I am depleted.

CORNISH: And, she said, I'm ready. Turns out Towson had yet another appointment at a rehab center the following week, but she was pretty sure it was just an interview and that there would be an additional wait. And she knows, even if she got a spot, she'd have to overcome her addiction and her own will.

TOWSON: Like, if somebody came up and said, Andrea, you can go to treatment right now, you know what I would say? Can you get me well first? It's always going to be there until I get it done.

CORNISH: This is how she talks about her addiction. She's well when she's had a hit. She's dope sick without the drugs. This is, as Towson calls it, her reality. She's an addict. She's HIV-positive. She's been off her medications for more than a year. And she's sitting in a park where people come looking for her when they want to get high. They know her as the doctor, someone who can help them hit a vein when they can't. But she doesn't want to be here. She says she wants peace of mind.

TOWSON: I don't have no peace of mind because I know that tomorrow I have to do the same thing again. I just want to be able to wake up and eat breakfast and be normal, whatever that might be. I'm just ready to be Andrea. Teacup is done. Yeah, she done. She'll always be a part of me, but I no longer want to be her. Teacup is a full-blown drug addict - full-blown. I choose to live now.

CORNISH: We don't know what's happened with Andrea Towson. Every day, we wonder whether she's made it into treatment or whether she's back on that park bench, answering to Teacup.

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CORNISH: Tomorrow, our conversation turns to how addiction is viewed in this country and why treatment is divorced from the rest of healthcare.

THOMAS MCLELLAN: It's quite easy to think of this as it has been thought of for literally hundreds of years - as a character disorder, as poor upbringing, as a problem of parenting. And that's how we approached it. It's not coincidence that the Justice Department has played such a pivotal role

CORNISH: Thomas McLellan, a pioneer in the science of substance abuse, on how the country could solve the problem of treating addiction and why he's still optimistic, even after losing a son to drugs. That's tomorrow on ALL THINGS CONSIDERED. Transcript provided by NPR, Copyright NPR.